Cover image for Depression and bipolar disorders
Depression and bipolar disorders
Edwards, Virginia, 1947-
Personal Author:
Publication Information:
New York : Firefly Books (U.S.) Inc., [2002]

Physical Description:
178 pages : illustrations ; 22 cm.
Format :


Call Number
Material Type
Home Location
Item Holds
RC537 .E39 2002 Adult Non-Fiction Non-Fiction Area

On Order



Depression is a deceptively common illness. At some point in their lives, one out of every five people will struggle with bouts of depression, and nearly twice as many women will be affected as men.

At the outset, depression can seem quite similar to the sadness or low moods that we all feel from time to time. As the illness progresses, however, work life, social life and intimate relationships all suffer. The affected person loses interest in those around him, feels exhausted and hopeless and often considers "giving up."

In Depression and Bipolar Disorders , Dr. Virginia Edwards explores the causes, symptoms and treatment of depressions. Topics include:

normal versus abnormal depression unipolar depressive disorders bipolar depressive disorders biological and psychosocial therapies depression in women and the elderly treatment options, including involuntary hospitalization suicide.

This comprehensive examination of depression also features case studies and an extensive resource list.

Author Notes

Dr. Virginia Edwards has been in private practice -- focusing on women's health and family issues -- for more than 30 years. She recently retired from her position as the head of Toronto East General Hospital's Child Psychiatry Department.



Chapter One Depression: Normal and Abnormal Antonio is forty years old, and has recurrent major depressive episodes. "Why do I have to suffer so much?" he asks. "All the things I can't do, the plans I can't make, because I don't know what shape I'll be in from one week to the next. For the last two days I haven't cared about anything, I haven't even taken a shower. I've just been trying to manage the pain of my own emotions. Tonight at dinner I started to feel sane, and then the despair hit me again, like a ton of bricks. I'm afraid one of these days my boss will fire me. How do I get healthy, and stay that way?" -- All of us experience feelings and emotions. These are signals that tell us if we are safe or in danger. They also communicate to others that we are upset or pleased. We can cope with changes in the world by tuning into our feelings, the signaling system that sends emotional messages that are universally recognizable, and interprets other people's emotions accurately. Feelings are the subjective awareness of emotions. In fact, feelings are present throughout mammalian species. Dogs and gorillas can signal happiness by jumping playfully and showing their teeth, much as humans do when they smile. The physical signs of the emotion, such as a smile, a grimace, a red face, clenched fists, or downcast eyes, indicate the state we're in to those around us. Although we are not always conscious of what we communicate, the signals we send, such as a raised voice, a cry, or a hunched posture, tell other people what responses we need from them. Sometimes we don't have time to think what to do in response. A stranger hears the distressed cry of someone drowning and, without thinking, jumps in to save the person. When the stranger is given a medal for heroism, he or she says there was no conscious act of bravery. The more varied our awareness and expression of our feelings, the healthier we are emotionally. Healthy families accept and encourage the expression and awareness of a full range of feelings in their children. They accept the children's anger, sadness, and joyfulness. They neither deny nor censor these feelings, although this doesn't mean the child is allowed to act in a hurtful way. Healthy families also accept other people's faults, and enjoy being with others. They are sociable and outgoing. That's the ideal. Most of us manage to approach it rather than achieve it. I can remember self-righteously criticizing someone for being bitter, only to realize the next day that I had been the negative one. Good therapy helps us relax our rigidity so we can experience the full range and richness of feelings. We need to feel angry, sad, happy, joyful, and a whole range of more subtle emotions to feel truly alive. Moods versus Depression A mood is a state of emotion sustained for a period of time. When we're in a "good mood" we feel buoyant, self-confident, and happy. We're interested in what's happening around us and want to explore new things. Usually something good has happened to us or we are having fun with people we like. We feel positive about ourselves and optimistic about the state of the world. Too bad we can't feel this way all the time! But if we did, we'd miss out on signs of danger. "Bad moods" start when we feel anxious, angry, frightened, or sad. Often these feelings are provoked by some external event -- not getting the promotion we wanted, finding out we're overdrawn at the bank, or, worse yet, learning that our company is downsizing or our partner is fed up and thinking of leaving the relationship. If we didn't feel anxious, irritable, sad, or frightened under these circumstances, we wouldn't be able to look out for our needs. We have to be able to take steps to protect ourselves from hurt and humiliation, so we can survive adversities and maintain our self-esteem. The word "depressed" can describe a feeling, as in "I'm so depressed that John didn't call for a date for Saturday night." It can also convey a more persistent state of low mood, as in "I've felt so depressed since I found out I was passed over for the promotion I'd worked so hard for, and I can't shake it." Usually, when we experience the feeling or mood as appropriate and understandable, we don't rush off to a doctor. We know we will cheer up when things change, or we took for other ways to handle our disappointments. Feeling blue, sad, defeated, depleted, or helpless is all part of being human. We experience these feelings when things go wrong in our world. Paradoxically, if we don't accept these feelings -- if we;'re rigid and controlled -- we experience even more emotional distress. Our energy gets used up in suppressing the feelings and denying the hurt. We give up but we don't know why. At this point, the illness of depression can result. How Depressed Is Depressed? Depression can be distinguished from sadness in a number of ways. The intensity of the sadness is more severe and painful. A sufferer may describe the pain as "worse than any physical pain." The pain is so unbearable that often you feel you would rather be dead. The sadness pervades all aspects of your life and can't be shaken off. The feeling takes on a life of its own; it seems detached from whatever the original painful event was, so that you can't be reasoned out of the horrible feelings. You feel guilty and worthless and reproach yourself for your failings. You are unable to express your feelings or experience pleasure. You have difficulty concentrating, feel unpleasant body sensations, are agitated or slowed down, and appear downcast and unsmiling. The above paragraph describes clinical depression. Several scales have been developed so that the doctor can assign a number value measuring the severity of the depression; these scales also give you a way to see if the depression is improving with treatment. The Patient Health Questionnaire A simple screening test called the Patient Health Questionnaire picks up many cases. If at least five of the following nine descriptions apply to you, and if these symptoms are increasing in frequency and severity over a two-week period, you likely have a depressive illness that should be treated. If your depression needs to be treated, you are unable to function in many areas of your life. You are impaired at home, at work, and with friends. If you have actively thought about suicide, you would be wise to get help as soon as possible. little interest or pleasure in doing things feeling down, depressed, or hopeless trouble falling or staying asleep, or sleeping too much feeling tired or having little energy poor appetite or overeating feeling bad about yourself, or feeling that you are a failure or have let yourself or your family down trouble concentrating while reading the newspaper or watching television moving or speaking so slowly that other people would notice, or the opposite -- being so fidgety or restless that you can't stop moving thinking that you would be better off dead, or thinking of hurting yourself in some way If you have only two or three of these symptoms, you should view them as a warning. Talking over your feelings and concerns with someone who cares about you may help. You could also lighten up the demands you make on yourself, spending less time working and more time enjoying yourself, although this isn't always possible. Looking after yourself with comfortable sleep, exercise, and nutritious food, and spending time with friends and family, can also help. If the feelings don't let up, you should see a doctor or counselor to talk over your problems. If you have more than four of these feelings or have suicidal thoughts, it's important to seek help from your doctor or a counselor. Lots of good help is available. You might start by seeing your family doctor. If the doctor feels you are depressed, he or she may decide to treat you personally, or may refer you to a psychiatrist, a medical specialist with four years of additional training in treating psychiatric illness. Both the family doctor and the psychiatrist can prescribe medication and conduct psychotherapy. Some health plans will pay for these services. Most general hospitals have a mental health clinic where people with depressive disorders can be treated. A psychologist or social worker, professionals trained in counseling people with depressive illnesses, may be assigned to treat you. Again, in-hospital services are usually covered by your health plan. Psychologists and social workers work as therapists in private practice as well. In Canada these services are not covered by provincial plans. However, some company health plans will pay for a designated number of sessions. In the United States, Medicare, Medicaid, and the health management organizations all have their own criteria for coverage. The Hamilton Psychiatric Rating Scale A more thorough scale for determining the severity of depressive illness is called the Hamilton Psychiatric Rating Scale for Depression. Dr. Max Hamilton first developed this test in 1960. Since then it has become a benchmark for measuring the level of depression. The Hamilton Scale has twenty-one categories with two to four ranges of severity. The categories are wide-ranging and include depressed mood, guilt feelings, sleep disturbances, weight loss, anxiety, agitation, body ailments, suicidal thoughts, and impaired thinking. Your doctor scores the form and gives a numerical rating for you initially, and then tracks your improvement with treatment. A score of 7 or less indicates no illness. A score between 13 and 17 usually indicates a treatable illness called dysthymia, explained in Chapter 2. A score between 18 and 25 indicates a major depressive disorder. A score between 26 and 30 shows a more severe form of depression called melancholia, and a score above 30 indicates very severe depression. Another scale, the Beck Depression Inventory, is scored by the patient, and likewise indicates levels of severity. Other Tests for Depression You can see that depression is a continuum from an exaggerated response to stress to incapacitating distress and disability. Over the years, scientists have tried to find biological markers or consistent changes in the chemistry of the body that can be measured to distinguish between normal responses to stress, which the person will recover from spontaneously, and debilitating illnesses that will improve only with active treatment. Often the first sign of a depressive episode is difficulty sleeping. The time between falling asleep and the onset of rapid eye movement (REM) sleep, otherwise known as dream sleep -- when the eyeballs move rapidly -- is shortened in someone who is depressed. A sleep lab taking an electroencephalogram (a test that shows brain-wave patterns) during the night can determine if a person has a sleep pattern characteristic of depression. This method of deciding if someone has a treatable depression is too expensive to use routinely, but it's helpful and is used in centers where research in depression takes place. In short, at the present time the diagnosis of depression is based on the amount of distress and disability the individual is suffering. Doctors and researchers hope that in the future they will find a measure that is simple and exact. The next two chapters explain the different categories of depression more thoroughly. New names of syndromes have been added as the various categories were studied more thoroughly. Many terms overlap and can describe the same symptoms. Chapters 2 and 3 will clarify some of these terms. Excerpted from Depression and Bipolar Disorders: Everything You Need to Know by Virginia Edwards All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.

Table of Contents

Chapter One Depression: Normal and Abnormal
Moods versus
How Depressed is Depressed?
Chapter Two Depressive Disorders
Major Depressive Episode
What Is Depressive Illness?
Types of Depressive Illness
Disorders Similar to Depression
Disorders Occurring with Depression
What Causes Depressive Illness?
Chapter Three Bipolar Disorders
Bipolar I
Bipolar II
Rapid Cycling Disorder
What Causes Biopolar Illness?
Chapter Four Getting Help
Taking Care of Yourself
When Is Professional Help Necessary?
Chapter Five Psychological Disorders
Choosing a Therapist
Cognitive Behavioral Therapy
Interpersonal Therapy
Short-Term Psychodynamic Psychotherapies
Combining Psychotherapy and Medication
Family-Focused Therapy
Cognitive Styles That Make Depression Worse
Psychosocial Therapy for Bipolar Illness
Chapter Six Medications and Other Therapies
The Brain in Depression
The Brain in Bipolar Illness
Drugs to Control Symptoms
Other Physical Treatments for Depression
Chapter Seven Complementary Treatments and Self-Help
Complementary Treatments
A Note to Family Members
Chapter Eight Depression in Children and Adolescents
Possible Signs of Childhood Depression
Causes of Depression in Children and Adolescents
Depression at Different Ages
Bipolar Disorders
Treatment of Depression and Bipolar Disorder in Children and Adolescents
Chapter Nine: Women and Depression
Having Children, Losing Children
Other Factors of Women's Psychology
Chapter Ten Depression in the Elderly
Physical Illnesses and Surgery
Cognitive Changes of Aging
Vascular Depression
Functional Disabilities
Mania in the Elderly
Giving Up Independence
Treating Depression in the Elderly
Chapter Eleven Suicidal Tendencies and Involuntary Hospitalization
Warning Signs
Who Commits Suicide?
The Emotional Aftermath of Suicide
Programs to Prevent Suicide
Involuntary Hospitalization
Chapter Twelve Stigma and Disability
Table of Drug Names
Further Resources